MRC Myobrace Beginner Course 2014 Part 2

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Myofunctional Research Company presents Myobrace Beginner Course by Dr. Barry Raphael at the Raphael Center for Integrative Education, Clifton, New Jersey, January 2014: Part 2

Myofunctional Research Company presents Myobrace Beginner Course by Dr. Barry Raphael at the Raphael Center for Integrative Education, Clifton, New Jersey, January 2014: Part 2

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  • 1. The Myobrace System -A hammer for a houseSat-Sun, January 18-19, 2014 dr. barry raphael the raphael center for integrative education www.alignmine.com drbarry@alignmine.com Day 1 PM Sunday, January 19, 14
  • 2. Dinner Tonight? $20 per person To talk about whatever… Sunday, January 19, 14
  • 3. The Goals of Airway-centric Myofunctional Orthodontics 1. 2. 3. 4. 5. 6. 7. 8. Sunday, January 19, 14 Breathing through the nose Lips together at rest Correct tongue position No facial muscles moving on swallowing Optimal facial development Class I occlusion Straight teeth Better Stability long term
  • 4. Airway-focused Orthodontics 1.Airway-focused Diagnostics 2.Prevention 3.Undo the Damage 4. Establish Good Habits 5.Interdisciplinary Treatment Sunday, January 19, 14
  • 5. Airway-focused Orthodontics 1.Airway-focused Diagnostics 2. Prevention 3.Undo the Damage already done 4. Establish Good Habits 5.Interdisciplinary Treatment Look for the source of the imbalance. Look for the causes, not just the symptoms. Sunday, January 19, 14
  • 6. Lesson #3 Don’t be a Barker Sunday, January 19, 14
  • 7. So what’s this? Sunday, January 19, 14
  • 8. It’s a Forest Sunday, January 19, 14
  • 9. Can you see it now? Sunday, January 19, 14
  • 10. Now? Sunday, January 19, 14
  • 11. Must be a forest.... Sunday, January 19, 14
  • 12. Aha! Sunday, January 19, 14
  • 13. Let’s try a different approach Sunday, January 19, 14
  • 14. What’s this? Sunday, January 19, 14
  • 15. A Person! Sunday, January 19, 14
  • 16. A Tree Stump Sunday, January 19, 14
  • 17. The Tree Sunday, January 19, 14
  • 18. Trees... Sunday, January 19, 14
  • 19. Here’s the forest! Sunday, January 19, 14
  • 20. Lesson #3: Don’t be a Barker Step back from the teeth Start by looking at the person and work your way in. Sunday, January 19, 14
  • 21. Level 1: Screening Chief Concern Medical History Body Form Body Function Facial Form Facial Function Intraoral Form Intraoral Function Sunday, January 19, 14
  • 22. Level 1: Screening Chief Concern Any Airway-related Craniofacial Dysfunction ARCD Medical History Sleep: Snoring, Chronic tiredness, Breathing: Loud breathing, URTI, allergy, asthma Body Form Body Function Forward Head posture, Frontal asymmetry Chest Breathing, BPM>14 Indicator Line excess,Venous pooling Facial Form Facial Function Open Mouth Posture, MFE movement on swallowing, Gothic Arch with crowding, Swollen tonsils Intraoral Form Intraoral Function Limited tongue lift Sunday, January 19, 14
  • 23. Level 2: Exam Chief Concern Medical History Age and Dental Age URT Asthma Swollen T &/or A Sleep: Snoring Restless Tiredness Hyperactivity Hx sleep study Body Form Frontal Posture Level of ears, eyes, shoulders, hips Ankle Pronation Lateral Posture Forward head Winged scapula Locked knees Forward knuckles Plumb line Slouching Body Function Gait Breathing mechanics Breathing rate Sunday, January 19, 14 Intraoral Function Facial Form Tongue: extension, frenum Cranial Tongue: resting posture Symmetry Tongue: thrust Midface profile Mandibular profile Intraoral Form Lips and indicator Tongue: U lip/L lip Scalloping Indicator line Frenum Incisal show Arch Form Posture at rest Gothic (V-shaped) Lip competence Molar width <35 Lip shape Deep Curve of Spee, bilevel Chapping Occlusion Mentalis Excess overbite Facial Function Openbite MM palpation Overjet Joint function Crossbite Nasal patency Wear faceting Eyes Angle Class Venus pooling Dental Alignment. Scleral show Crowding Malar tangent Impaction Oral rest posture Missing or extra Swallow and articulation Tooth size discrepancy Facial muscle movement Mentalis contraction Cheeks These are items to look for in Head bob addition to your normal dental exam
  • 24. Level 2: Exam Chief Concern Medical History Body Form Body Function Facial Form Facial Function Intraoral Function Intraoral Form Sunday, January 19, 14 Why are you here? What have you seen in your child? What do you know already? What does your child want? What do you want for your child? How did you hear about us? _____________________
  • 25. Level 2: Exam Chief Concern Medical History Body Form Body Function Facial Form Facial Function Intraoral Function Intraoral Form Sunday, January 19, 14 Age and Dental Age URT Asthma Swollen T &/or A Sleep: Snoring Restless Tiredness or hyperactivity HX Sleep Study _____________________
  • 26. Level 2: Exam Chief Concern Medical History Body Form Body Function Facial Form Facial Function Intraoral Function Intraoral Form Sunday, January 19, 14 Frontal Posture Level of ears, eyes, shoulders, hips Ankle Pro-, Supination Lateral Posture Forward Head Winged Scapula Locked Knees Forward Knuckles Plumb line Slouching
  • 27. Level 2: Exam Chief Concern Medical History Body Form Body Function Facial Form Facial Function Intraoral Function Intraoral Form Sunday, January 19, 14 Body Function Gait Breathing mechanics Breathing rate
  • 28. Level 2: Exam Chief Concern Medical History Body Form Body Function Facial Form Facial Function Intraoral Function Intraoral Form Sunday, January 19, 14 Facial Form Cranial Symmetry Midface profile Mandibular profile Lips and indicator U lip/L lip Indicator line Incisal show Posture at rest Lip competence Lip shape Chapping Mentalis
  • 29. Level 2: Exam Chief Concern Medical History Body Form Body Function Facial Form Facial Function Intraoral Function Intraoral Form Sunday, January 19, 14 Facial Function MM palpation Joint function Nasal patency Eyes Venus pooling Scleral show Malar tangent
  • 30. Level 2: Exam Chief Concern Medical History Body Form Body Function Facial Form Facial Function Intraoral Function Intraoral Form Sunday, January 19, 14 Intraoral Function Tongue: extension, frenum Tongue: resting posture Tongue: thrust
  • 31. Level 2: Exam Chief Concern Medical History Body Form Body Function Facial Form Facial Function Intraoral Function Intraoral Form Sunday, January 19, 14 Intraoral Form Tongue: Scalloping Frenum Arch Form Gothic (V-shaped) Molar width <35 Deep Curve of Spee, bilevel Occlusion Excess overbite Openbite Overjet Crossbite Wear faceting Angle Class Dental Alignment. Crowding Impaction Missing or extra Tooth size discrepancy
  • 32. Level 3 Exam: Complete Health History (see notebook) Sunday, January 19, 14
  • 33. History Taking • Medical/Myofunctional History • Sleep Scale • Home Observation • Systems Review Worksheet Sunday, January 19, 14
  • 34. Home Observation •Private Eye sheet Dr. Raphaelʼs Parentʼs Private-Eye Home Sheet There are many things about your childʼs health that are important to know, but that I often donʼt get to see at the office. Also, there are signs to look for that you may not have known were connected to your childʼs teeth or health. By looking for and tracking these “signs and symptoms”, we can get a better handle on the problem and watch for resolution. You donʼt have to spend a lot of time with this. Just watch for certain things at different times of day. Try not to let your child know they are being watched. You want to see the most natural behaviors. Check off what you see. If youʼre not sure, check it anyway. Make comments if you want. While sitting around (watching TV, in the car), does your child: put “things” in the mouth alot (toys, sleeves, pencils, fingernails, etc.) ______________________________ lick or suck on the lips have the lips apart, even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open, even a little bit make noises when breathing have trouble sitting still During a meal, does your child: gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink alot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin “crinkle” when swallowing bob the head when swallowing have trouble sitting still While sleeping, does your child: have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes While talking, does your child: talk very fast talk very slowly gasp for air have a lisp take speech lessons Raphael PES v1.1 2011 Sunday, January 19, 14
  • 35. Home Observation Dr. Raphaelʼs Parentʼs Private •Private Eye sheet There are many things about your childʼs health that are important to know, but that I often donʼt get to see at the office. Also, there are signs to look for that you may not have known were connected to your childʼs teeth or health. By looking for and tracking these “signs and symptoms”, we can get a better handle on the problem and watch for resolution. You donʼt have to spend a lot of time with this. Just watch for certain things at different times of day. Try not to let your child know they are being watched. You want to see the most natural behaviors. Check off what you see. If youʼre not sure, check it anyway. Make comments if you want. Sunday, January 19, 14 During a gasp stick whe stick drink drink mak eat s take puff mak mak swal bob have While sle
  • 36. While sitting around (watching TV, in the Home Observation •Private Eye sheet car), does your child: put “things” in the mouth alot (toys, sleeves, pencils, fingernails, etc.) ______________________________ lick or suck on the lips have the lips apart, even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open, even a little bit make noises when breathing have trouble sitting still While talking, does your child: talk very fast talk very slowly gasp for air have a lisp take speech lessons Sunday, January 19, 14 While s ha sn we tos tilt wa ha ha gri ha wa
  • 37. Home Observation aelʼs Parentʼs Private-Eye Home Sheet your childʼs now, but that I office. Also, there may not have Eye Private ur childʼs teeth or sheet acking these an get a better watch for • t of time with this. at different times ld know they are see the most uʼre not sure, ments if you want. Sunday, January 19, 14 During a meal, does your child: gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink alot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin “crinkle” when swallowing bob the head when swallowing have trouble sitting still
  • 38. ents if you want. Home Observation ching TV, in the h alot (toys, nails, etc.) ____________ •Private Eye n a little sheet out of the between the nd pen, even a little athing ild: Sunday, January 19, 14 While sleeping, does your child: have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
  • 39. Home Observation •Private Eye sheet •Medical Hx on backside Dr. Raphaelʼs Parentʼs Private-Eye Home Sheet There are many things about your childʼs health that are important to know, but that I often donʼt get to see at the office. Also, there are signs to look for that you may not have known were connected to your childʼs teeth or health. By looking for and tracking these “signs and symptoms”, we can get a better handle on the problem and watch for resolution. You donʼt have to spend a lot of time with this. Just watch for certain things at different times of day. Try not to let your child know they are being watched. You want to see the most natural behaviors. Check off what you see. If youʼre not sure, check it anyway. Make comments if you want. While sitting around (watching TV, in the car), does your child: put “things” in the mouth alot (toys, sleeves, pencils, fingernails, etc.) ______________________________ lick or suck on the lips have the lips apart, even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open, even a little bit make noises when breathing have trouble sitting still During a meal, does your child: gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink alot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin “crinkle” when swallowing bob the head when swallowing have trouble sitting still While sleeping, does your child: have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes While talking, does your child: talk very fast talk very slowly gasp for air have a lisp take speech lessons Raphael PES v1.1 2011 Sunday, January 19, 14
  • 40. Myofunctional History STD Examination Medical History Eating AgeEruption Early N Late Chewing Difficult Sloppy Digestive N Problems Food Allergies _______________ BreastFed _________ mos Pacifier to age _____ SippyCup Habits Finger Thumb OralFixation Pacifier Nail Other___________ Airway recurrent ear infections Y recurrent sinus infections Y T&A Y Rx’d Sleeping mouth posture open closed Snoring Y Apnea Dx’d Allergies to____________________________ Tested? Y M.D. _________________________ Meds ____________________________ Symptoms Nasal Skin Breathing Family Hx Asthma Y Dx’d M.D._________________________ Meds___________________ Precautions __________________________________________________________ Family Hx_____________________________________________________________ When things are "normal" do you have trouble breathing? Y N Triggers _____________________ Last Episode date ______________________ Outcome _________ Intensity Mild Mod Severe Frequency Intermittent Persistent Physical Exam: Height _______ Weight _________ Posture: Feet Spinal curvature Hips level R L High Shoulders Level R L High Head balance Forward Neutral Behind Facial Shape Brachy Meso Dolico Ears N In Out Eyes Wide N Narrow RHigh LHigh Pooling Nose Hump Crease Nares Flare Maxilla Full Flat OrbitalShow To bridge ______mm Lower 1/3 Long N Short Lips At Rest Open Partial Closed LipsClosed Relaxed Tight Mentalis Vermillion larger U Equal L Entrapment L Protrusion U L Interlabial Line Center Up Flat Down Upper lip Short N Mand Retro N Prog Smile Display Incisor Gummy Narrow Corridors Cant Sunday, January 19, 14
  • 41. Sleep Scale Pediatric Sleep Questionnaire: Sleep-Disordered Breathing Subscale Licensed to: the raphael center for integrative orthodontics 070129 •© Regents of the University of Michigan 2006 Score = #Y / (# Y + #N). >.33 = significant Child’s Name: ______________________________ Person completing form: _____________________ Study ID #: ___________ Date: ____/____/____ Please answer these questions regarding the behavior of your child during sleep and wakefulness. The questions apply to how your child acts in general during the past month, not necessarily during the past few days since these may not have been typical if your child has not been well. You should circle the correct response or print your answers neatly in the space provided. A “Y” means “yes,” “N” means “no,” and “DK” means “don’t know.” WHILE SLEEPING, DOES YOUR CHILD: Snore more than half the time?………………………………………...…. ……..Y Always snore? ………………………………………………………………..Y Snore loudly? …………………………………………………………………Y Have “heavy” or loud breathing? …………………………………….…………..Y Have trouble breathing, or struggle to breathe? …………………….……………Y N N N N N DK DK DK DK DK A3 A4 A5 A6 HAVE YOU EVER SEEN YOUR CHILD STOP BREATHING DURING THE NIGHT? ……………………………………………………………………….Y N DK A7 3. DOES YOUR CHILD: Tend to breathe through the mouth during the day?…………………………….Y Have a dry mouth on waking up in the morning? …..………………...Y Occasionally wet the bed? ……………………………………………...Y N N N DK DK DK A24 A25 A32 4. DOES YOUR CHILD: Wake up feeling unrefreshed in the morning? ………………………………….Y Have a problem with sleepiness during the day? ………………….……….…...Y N N DK DK B1 B2 HAS A TEACHER OR OTHER SUPERVISOR COMMENTED THAT YOUR CHILD APPEARS SLEEPY DURING THE DAY? …………………………….…Y N DK B4 IS IT HARD TO WAKE YOUR CHILD UP IN THE MORNING? …………….…Y N DK B6 7. DOES YOUR CHILD WAKE UP WITH HEADACHES IN THE MORNING?…..Y N 1. 2. 5. 6. A2 DK B7 DID YOUR CHILD STOP GROWING AT A NORMAL RATE AT ANY TIME SINCE BIRTH? …………………………………………………….….Y N DK B9 9. IS YOUR CHILD OVERWEIGHT? ………………………………………………...Y N DK B22 10. THIS CHILD OFTEN: Does not seem to listen when spoken to directly. ……………………………....Y Has difficulty organizing tasks and activities. …………………….…………...Y Is easily distracted by extraneous stimuli. ………………………….…………...Y Fidgets with hands or feet or squirms in seat. ……………………………….....Y Is “on the go” or often acts as if “driven by a motor”. …………………………Y Interrupts or intrudes on others (eg., butts into conversations or games). ………Y N N N N N N DK DK DK DK DK DK C3 C5 8. C8 C10 C14 C18 Thank you! © Regents of the University of Michigan 2006 Score = #Y / (# Y + #N). >.33 = significant Sunday, January 19, 14
  • 42. Pediatric Sleep Questionnaire: Sleep-Disordered Breathing Subscale Licensed to: the raphael center for integrative orthodontics 070129 Child’s Name: ______________________________ Person completing form: _____________________ Study ID #: ___________ Date: ____/____/____ Please answer these questions regarding the behavior of your child during sleep and wakefulness. The questions apply to how your child acts in general during the past month, not necessarily during the past few days since these may not have been typical if your child has not been well. You should circle the correct response or print your answers neatly in the space provided. A “Y” means “yes,” “N” means “no,” and “DK” means “don’t know.” WHILE SLEEPING, DOES YOUR CHILD: Snore more than half the time?………………………………………...…. ……..Y Always snore? ………………………………………………………………..Y Snore loudly? …………………………………………………………………Y Have “heavy” or loud breathing? …………………………………….…………..Y Have trouble breathing, or struggle to breathe? …………………….……………Y N N N N N DK DK DK DK DK A5 A6 HAVE YOU EVER SEEN YOUR CHILD STOP BREATHING DURING THE NIGHT? ……………………………………………………………………….Y N DK A7 3. DOES YOUR CHILD: Tend to breathe through the mouth during the day?…………………………….Y Have a dry mouth on waking up in the morning? …..………………...Y Occasionally wet the bed? ……………………………………………...Y N N N DK DK DK A24 A25 A32 4. DOES YOUR CHILD: Wake up feeling unrefreshed in the morning? ………………………………….Y Have a problem with sleepiness during the day? ………………….……….…...Y N N DK DK B1 B2 1. 2. Sunday, January 19, 14 A2 A3 A4
  • 43. MFO Treatment Worksheet Priority Issue: What I am Action for looking Trainer Sunday, January 19, 14 Referral
  • 44. MFO Treatment Worksheet Sunday, January 19, 14
  • 45. MFO Treatment Worksheet Sunday, January 19, 14
  • 46. MFO Treatment Worksheet Sunday, January 19, 14
  • 47. MFO Treatment Worksheet Sunday, January 19, 14
  • 48. MFO Treatment Worksheet Sunday, January 19, 14
  • 49. MFO Treatment Worksheet Sunday, January 19, 14
  • 50. MFO Treatment Worksheet Sunday, January 19, 14
  • 51. MFO Treatment Worksheet Sunday, January 19, 14
  • 52. MFO Treatment Worksheet Sunday, January 19, 14
  • 53. MFO Treatment Worksheet Sunday, January 19, 14
  • 54. MFO Treatment Worksheet Sunday, January 19, 14
  • 55. MFO Treatment Worksheet Sunday, January 19, 14
  • 56. MFO Treatment Worksheet Sunday, January 19, 14
  • 57. MFO Treatment Worksheet Sunday, January 19, 14
  • 58. MFO Treatment Worksheet Sunday, January 19, 14
  • 59. MFO Treatment Worksheet Sunday, January 19, 14
  • 60. Clinical Exam* Rough Order of Examination •Body •Breathing •Head •Face •Mouth •Teeth *To be added to your normal routine Sunday, January 19, 14
  • 61. Lateral Posture Plumb Line Through... 1.Ext Aud Meatus 2.Shoulder 3.Hip (greater trochanter 4.Knee 5.Ankle Forward Head Posture Sunday, January 19, 14
  • 62. Posture Analysis Sunday, January 19, 14
  • 63. Sunday, January 19, 14
  • 64. Sunday, January 19, 14
  • 65. Nasopharyngeal Obstruction From Kent Lauson “Straight Talk about Crooked Teeth” Sunday, January 19, 14
  • 66. Nasopharyngeal Obstruction and its effects Enlarged Tonsils & Adenoids Deviated Nasal Septum Nasal Constriction Cysts, Polyps & Tumors Enlarged Turbinates Allergic Rhinitis NASOPHARYNGEAL OBSTRUCTION Blockage of Eustachian Tubes Accumulation of Inflamed and pathogens in enlarged turbinates Eustachian Tubes & nasal passages Otitis media (middle ear infection) Frequent colds & sore throats, respiratory infections Hearing Loss Disease Behavior disorders Reduced energy Reduced mental capacity ADD ADHD SIDS Mouth Breathing Lowered Tongue Posture Gingivitis, chapped lips, bad breath, dry mouth, high decay rate Hypertrophied palatal tissues (no tongue pressure) Constricted nasal cavity Lack of space for tongue Airway Obstruction: dorsum of tongue against oropharyngeal wall or soft paltate Obstructive Sleep Apnea Lowered O2 Intake Snoring Sleep Cycle Dysfunction Pulmonary Hypertension Daytime Drowsiness Cardiac Hypertension Reduced Quality of Life Mandible with lowered and retruded posture Bucco-lingual maxillary muscle imbalance Constricted and underdeveloped maxilla Constricted nasal cavity High V-shaped palate Mouth breathing increased Lowered tongue posture Poor self image Anti-social behavior Poor Nutrition Susceptibility to disease Bruxism Craniomandibular dysfunction TMJ Dysfunction TMJ condyle and disc displacement TMJ degeneration and osteoarthritis Sunday, January 19, 14 Anterior open bite Poor lip seal Neuro-muscular dysfuntion Neck muscle strain Gummy smile Loss of lordotic curve of cervical spine Speech problems, lisps, hyponasality Malocclusion, crowding, overbite, crossbite, loss of vertical dimension Difficulty eating Excess vertical development Tongue Thrust Constricted, retruded and underdeveloped mandible Poor facial appearance Forward head and shoulder posture Malocclusion, open bite, long face syndrome, prognathism May result in lack of skeletal muscle strength and coordination Myofascial pain dysfunction syndrome Headaches, neck aches, ear pain, ringing/fullness, hearing loss, visual problems, limited or painful opening of jaw, neurologic disorders such as Parkinson’s, Tourette’s syndrome Neck aches, headaches
  • 67. Checking Breathing •Breathing • Rate • 10-14 • 15-20 • >22 • Movements • Chest • Diaphragm • Sounds Sunday, January 19, 14 This can be done by the assistant , while the patient isn’t watching looking for chronic hyperventilation looking for chronic hyperventilation
  • 68. Facial Measurement Routine 1.Indicator line 2.Upper lip 3.Lower lip to chin 4.Competence at rest 5.Incisal show 6.Strain on lip closure Sunday, January 19, 14
  • 69. Indicator Line Sunday, January 19, 14
  • 70. Maxillary Height • Indicator Line (Mew) • Distance from most anterior point on nose to upper incisal edge • Age + 23 • A variable number, but important to watch over time. Sunday, January 19, 14
  • 71. From the tip of the Central... Sunday, January 19, 14
  • 72. ...To the Forwardmost Tip of the Nose 41mm Sunday, January 19, 14
  • 73. Indicator Line 12 yo male Ideal IL = 35mm Watch during growth for >1mm increase / year 35mm Watch during 42mm treatment for increase or decrease Sunday, January 19, 14
  • 74. Take another look... ` Sunday, January 19, 14
  • 75. Indicator Line Incisor falls faster than the nose with vertical growth and retractive/extrusive mechanics Sunday, January 19, 14
  • 76. Facial Measurement Routine 1.Indicator Line 2.Upper lip 3.Lower Lip to chin 4.Competence at rest 5.Incisal show 6.Strain on lip closure 7.Maximum Opening 8.Tongue-to-Spot Opening Sunday, January 19, 14 Norm =18-20mm
  • 77. Facial Measurement Routine 1.Indicator Line 2.Upper lip 3.Lower Lip to chin 4.Competence at rest 5.Incisal show 6.Strain on lip closure 7.Maximum Opening 8.Tongue-to-Spot Opening Sunday, January 19, 14 Double Upper Lip
  • 78. Facial Measurement Routine 1.Indicator Line 2.Upper lip 3.Lower Lip to chin 4.Competence at rest 5.Incisal show 6.Strain on lip closure 7.Maximum Opening 8.Tongue-to-Spot Opening Sunday, January 19, 14
  • 79. Facial Measurement Routine 1.Indicator Line 2.Upper lip 3.Lower Lip to chin 4.Competence at rest 5.Incisal show 6.Strain on lip closure 7.Maximum Opening 8.Tongue-to-Spot Opening Sunday, January 19, 14
  • 80. Facial Measurement Routine 1.Indicator Line 2.Upper lip 3.Lower Lip to chin 4.Competence at rest 5.Incisal show 6.Strain on lip closure Sunday, January 19, 14
  • 81. Facial Measurement Routine 1.Indicator Line 2.Upper lip 3.Lower Lip to chin 4.Competence at rest 5.Incisal show 6.Strain on lip closure Sunday, January 19, 14
  • 82. Facial Measurement Routine 1.Indicator Line 2.Upper lip 3.Lower Lip to chin 4.Competence at rest 5.Incisal show 6.Strain on lip closure Sunday, January 19, 14
  • 83. Facial Measurement Routine 1.Indicator Line 2.Upper lip 3.Lower Lip to chin 4.Competence at rest 5.Incisal show 6.Strain on lip closure 7.Lip Condition Sunday, January 19, 14
  • 84. Soft Tissue Evaluation and Diagnosis Occlusion - CI CII CIII - normal overbite/Overjet open bite deep bite. Sunday, January 19, 14
  • 85. Soft Tissue Evaluation and Diagnosis Tongue position - normal lowered between teeth. Sunday, January 19, 14
  • 86. What is wrong with these children? Only correct diagnosis can lead to correct treatment Videos courtesy of Dr. John Flutter Sunday, January 19, 14
  • 87. Swallowing Styles... Sunday, January 19, 14
  • 88. What do you see? 12 things • Open mouth posture • Long lower third • Eye shadows • Allergic crease • Anterior Tongue Thrust • Anterior Open Bite • Lisp • Takes breath before swallow • Throws head back to swallow •Left ear high and rotated out • Dull eyes Sunday, January 19, 14 Also look for: T&A Allergies Lingual Frenum Pronated Feet and Rotated Pelvis Hypocapnia
  • 89. What do you see? 10 things • Shoulder Breathing • Open mouth posture • Facial muscles active on swallow (woodpecker) • Head dip on swallow • Stuffy Nose • Gothic Arch • Breathing Before drinking • Anterior Tongue Thrust •Right ear high Sunday, January 19, 14 Also look for: Frenum Bruxism T&A Hypocapnia
  • 90. What do you see? 11 things • Open Mouth Posture • Blows cheeks • Lip activity on swallow • Cheek activity • Hypermentalis • Anterior tongue thrust • Larger lower lip • Muscular definition below lower lip border • Temporal bone rotation • Bigger, higher right eye • Tiny nostrils Sunday, January 19, 14 Also look for: Frenum T&A Tongue between teeth on swallow
  • 91. What do you see? 7 things • Lips active on swallow • Open Mouth Posture • Mentalis action on swallow • Contraction of Buccinator on swallow • Lip Entrapment • Left Ear rotation • Muscular definition around lips Sunday, January 19, 14 Also look for: Forward Head Posture Scalloping on Tongue
  • 92. What do you see? 6 things • Blows out cheeks • Hypermentalis • Tight lip muscles on swallow • Lateral mandibular shift • Bimaxillary Retrusion • Concave profile Also look for: Tongue between teeth Class II div 2 Tongue Scalloping Sunday, January 19, 14
  • 93. What do you see? 10 things • Lateral head tilt • Temporal rotation • Long lower 1/3 • Asymmetrical upper lip movement • Mentalis • Eye shadows • Midface deficiency • Blows cheeks • Lower lip eversion • Small oral aperture Sunday, January 19, 14 Also look for: Tongue Scalloping High Vault Frenum T&A
  • 94. Face: Joints Sunday, January 19, 14
  • 95. Intraoral Measurement Routine 1.Maximum opening 2.Tongue-to-spot opening 3.Molar width 4.Palatal vault 1. Shape 2.Color 5.Malampati 6.Uvula 7.Tonsil grading Sunday, January 19, 14
  • 96. Intraoral Measurement Routine 1.Maximum Opening 2.Tongue To Spot Opening 3.Molar Width 4.Palatal Vault 1. Shape 2.Color 5.Malampati 6.Uvula 7.Tonsil Grading Sunday, January 19, 14
  • 97. Intraoral Measurement Routine 1.Maximum Opening 2.Tongue To Spot Opening 3.Molar Width 4.Palatal Vault 1. Shape 2.Color 5.Malampati 6.Uvula 7.Tonsil Grading Sunday, January 19, 14 50% of Max Opening
  • 98. Start “Clucks”, to Caves From Paula Fabbie, COM Sunday, January 19, 14
  • 99. Intraoral Measurement Routine 1.Maximum Opening 2.Tongue To Spot Opening 3.Molar Width 4.Palatal Vault 1. Shape 2.Color 5.Malampati 6.Uvula 7.Tonsil Grading Sunday, January 19, 14 Modern Average: 35mm Paleo Average: 50mm
  • 100. Intraoral Measurement Routine 1.Maximum Opening 2.Tongue To Spot Opening 3.Molar Width 4.Palatal Vault 1. Shape 2.Color 5.Malampati 6.Uvula 7.Tonsil Grading Sunday, January 19, 14
  • 101. Intraoral Measurement Routine 1.Maximum Opening 2.Tongue To Spot Opening 3.Molar Width 4.Palatal Vault 1. Shape 2.Color 5.Malampati 6.Uvula 7.Tonsil Grading Sunday, January 19, 14 Palatal Cyanosis Proper contact of the tongue on the palate and the negative pressure causes proper oxygenation of the palatal tissue. Lack of pressure of the tongue and the positive air pressure inhibits oxygenation and the palate will look cyanotic - yellowish/blueish in a caucasian.
  • 102. Intraoral Measurement Routine 1.Maximum Opening 2.Tongue To Spot Opening 3.Molar Width 4.Palatal Vault 1. Shape 2.Color 5.Malampati 6.Uvula 7.Tonsil Grading Sunday, January 19, 14
  • 103. Intraoral Measurement Routine 1.Maximum Opening 2.Tongue To Spot Opening 3.Molar Width 4.Palatal Vault 1. Shape 2.Color 5.Malampati 6.Uvula 7.Tonsil Grading Sunday, January 19, 14
  • 104. Intraoral Measurement Routine 1.Maximum Opening 2.Tongue To Spot Opening 3.Molar Width 4.Palatal Vault 1. Shape 2.Color 5.Malampati 6.Uvula 7.Tonsil Grading Sunday, January 19, 14
  • 105. Intraoral Measurement Routine 1.Maximum Opening 2.Tongue To Spot Opening 3.Molar Width 4.Palatal Vault 1. Shape 2.Color 5.Malampati 6.Uvula 7.Tonsil Grading Sunday, January 19, 14
  • 106. Functional Exams • Lip tone testing • Capnometry • Sleep screening • Videography and reading the face Sunday, January 19, 14
  • 107. Sunday, January 19, 14
  • 108. 2 CO •Blood Gas •Capnometer •Pulse oximeter Sunday, January 19, 14 Monitoring
  • 109. Sleep Screening Sunday, January 19, 14
  • 110. Cardio-Pulmonary Coupling Dr. Robert Thomas Electrocortical Modulation Heart Rate Variability Respiratory rate High Freq Coupling Low Freq Coupling Very Low Freq Coupling Sunday, January 19, 14
  • 111. Sleep Quality Index Stable Sleep Unstable Sleep Sunday, January 19, 14 SQI = HFC:LFC
  • 112. SleepImage M1 monitor • Monitor •Carry Case • Software (PC) • Reports • Scheduling • Help • Cable • Batteries supplied • Patches supplied • PhD reads reports $185/month Sunday, January 19, 14 www.sleepimage.com
  • 113. Imaging • Photography • Videography • Cephalometrics • 3D Imaging Sunday, January 19, 14
  • 114. Airway-focused Orthodontics 1.Airway-focused Diagnostics Tomorrow... 2.Prevention 3.Undo the Damage already done 4. Establish Good Habits 5.Interdisciplinary Treatment Our ultimate goal is to keep children from getting sick. By knowing the causes, we can prevent the disease. Sunday, January 19, 14
  • 115. Airway-focused Orthodontics Tomorrow... 1.Airway-focused Diagnostics 2. Prevention 3.Undo the Damage already done 4. Establish Good Habits 5.Interdisciplinary Treatment As much as possible, reverse the condition TOWARD the genetically programmed ideal. Sunday, January 19, 14
  • 116. Airway-focused Orthodontics 1.Airway-focused Diagnostics 2. Prevention 3.Undo the Damage already done 4. Establish Good Habits 5.Interdisciplinary Treatment Retraining Proper Oral-Rest Posture, Oral Function, and other good health habits for a lifetime of stability Sunday, January 19, 14
  • 117. Arch Development in conjunction with the TRAINER System™ Recommended Age Group: 5-12 yrs Sunday, January 19, 14
  • 118. Trainer Influence of Pre-Orthodontic Trainer treatment on the perioral and masticatory muscles in patients with Class II division 1 malocclusion 1. Tancan Uysal*,**, Ahmet Yagci*, Sadik Kara*** and Sukru Okkesim*** European Journal of Orthodontics ,2011, Volume 34, Issue 1 Pp. 96-101 “...POT appliance showed a positive influence on the masticatory and perioral musculature.” Sunday, January 19, 14
  • 119. 3. The Myobrace System 1.History and Purpose 2.Types and uses 3.Clinical Protocols 4.Patient Education and Motivation 5.Follow-ups and Trouble shooting Sunday, January 19, 14
  • 120. 3. The Myobrace System 1.History and Purpose 2.Types and uses 3.Clinical Protocols 4.Patient Education and Motivation 5.Follow-ups and Trouble shooting Sunday, January 19, 14
  • 121. Sunday, January 19, 14
  • 122. Dr Chris Farrell Dr Chris Farrell BDS SYDNEY UNIVERSITY, AUSTRALIA • Dr. Farrell graduated from Sydney University in 1971. • Since that time he has been a clinician in private practice in Australia and England. • Was not comfortable with the excessive extraction of teeth required by the orthodontists at the time. • Received much education from Dr. John Mew (UK) and Dr. Harold Gelb USA. Greatly influenced by Garliner, Prof. Hinz and Prof. Frankel - All of whom were looking beyond the teeth and onto faces, muscles and posture. • Observation and extensive study of research over the years showed that extraction of teeth did not resolve orthodontic crowding and craniofacial discrepancies. • He realised that newer techniques had to be developed to treat these many patients more effectively. • Now practices treating children and adults for Orthodontics and TMJ exclusively. • Dr. Farrell holds three worldwide patents for new dental appliances and is developing other innovations in his practice in Queensland, Australia, specific to the early treatment of orthodontic problems in children and TMJ disorder in adults. Sunday, January 19, 14 Dr Chris Farrell BDS SYDNEY UNIVERSITY,
  • 123. Dr Farrell produces the Ortho TRAINER The Ortho Trainer Sunday, January 19, 14 World First use of 3D solid modeling and stereo-lithography on intra-oral appliance
  • 124. MRC HEAD OFFICE AUSTRALIA Sunday, January 19, 14
  • 125. MRC MEGA CLINICS COOMERA VISITING ORTHODONTISTS FROM JAPAN AND RUSSIA Sunday, January 19, 14
  • 126. MRC EUROPE MRC EUROPE office Waalwijk, NETHERLANDS Sunday, January 19, 14
  • 127. MRC USA MRC USA office Southern CALIFORNIA Sunday, January 19, 14
  • 128. MRC USA Sunday, January 19, 14
  • 129. DR FARRELL presents 2012 LECTURE to MYOFUNCTIONAL ORTHODONTICS ORTHODONTISTS AND DENTISTS IN JAPAN Sunday, January 19, 14
  • 130. MRC CLINICS TRAINING CENTER AUSTRALIA Sunday, January 19, 14
  • 131. MRC CLINICS ROBINA and SYDNEY 2.5 x 3.4 4.6 x 3.4 1.2 x 2.8 3.8 x 2.8 3.2 x 3.8 3.5 x 4.3 1.9 10.17 3.2 x 3.8 2.3 3.5 x 5.0 1.2 2.5 x 2.9 2.6 2.95 x 2.9 2.95 x 2.8 3.0 x 1.7 2.95 x 2.8 3.5 x 4 2.3 x 2.3 3.2 x 1.8 DESIGNED and CONSTRUCTED by MRC Sunday, January 19, 14
  • 132. MRC CLINICS ROBINA and SYDNEY DESIGNED and CONSTRUCTED by MRC Sunday, January 19, 14
  • 133. MYOFUNCTIONAL ORTHODONTICS the new approach to the diagnosis, treatment and clinical management of malocclusion Vanee Ganesaratnam BOralH (Griffith Univ) Oral Health Therapist Orafacial Myologist Sunday, January 19, 14 Dr Chris Farrell BDS Sydney Dr Rohan Wijey BOralH, Grad Dip Dent (Griffith)
  • 134. MRC CLINICS® PRACTICE MANAGEMENT SYSTEM MYOFUNCTIONAL RESEARCH CO Goal over the last 20 years “Improve the facial and dental development of the growing child by treatment and prevention of mouth breathing and detrimental myofunctional habits.” Our goal is to have healthier children for life. Sunday, January 19, 14
  • 135. 3. The Myobrace System 1.History and Purpose 2.Types and uses 3.Clinical Protocols 4.Patient Education and Motivation 5.Follow-ups and Trouble shooting Sunday, January 19, 14
  • 136. PRIMARY DENTITION Sunday, January 19, 14 MIXED DENTITION DEVELOPING PERMANENT DENTITION PERMANENT DENTITION
  • 137. Sunday, January 19, 14
  • 138. STAGE 1 HABIT CORRECTION 4-6 MONTHS Sunday, January 19, 14 STAGE 2 ARCH EXPANSION 4-6 MONTHS STAGE 3 FINAL ALIGNMENT & RETENTION 4-6 MONTHS
  • 139. THE MYOBRACE SYSTEM™ Myobrace® appliance group generally consists of three appliances covering three stages of treatment. MIXED DENTITION - Kids SERIES STAGE 1 HABIT CORRECTION STAGE 2 ARCH EXPANSION STAGE 3 FINAL ALIGNMENT & RETENTION Nasal Breathing Lips Together Tongue on the palate 4-6 MONTHS Sunday, January 19, 14 4-6 MONTHS 4-6 MONTHS
  • 140. MYOBRACE FOR ™ KIDS - K1 Made of flexible silicone to adapt to any arch-form and poorlyaligned teeth.Its flexible nature means that it offers improved retention for night-time use. Breathing holes assist the transition to correct nasal breathing. Extended lip bumper discourages strong, overactive lip muscles. Sunday, January 19, 14
  • 141. MYOBRACE FOR ™ KIDS - K2 Features Dynamicore™ with a Frankel Cage which assists in developing the arch-form and improving the dental alignment. Tongue tag, guard and elevators train the tongue to position properly. Extended lip bumper discourages strong, overactive lip muscles. Sunday, January 19, 14
  • 142. MYOBRACE FOR ™ KIDS - K3 Firm polyurethane construction provides excellent tooth alignment and retention. Hollow tongue tag; tongue guard and elevators train the tongue to sit in final correct position and prevent thumb sucking. Extended lip bumper discourages strong, overactive lip muscles. Sunday, January 19, 14
  • 143. Sunday, January 19, 14
  • 144. STAGE 1 HABIT CORRECTION Sunday, January 19, 14 STAGE 2 ARCH EXPANSION STAGE 3 FINAL ALIGNMENT & RETENTION
  • 145. Sunday, January 19, 14
  • 146. STAGE 1 HABIT CORRECTION Sunday, January 19, 14 STAGE 2 ARCH EXPANSION STAGE 3 FINAL ALIGNMENT & RETENTION
  • 147. MYOBRACE FOR INTERCEPTIVE CLASS ™ III - I3N Flexible silicone adapts to any arch-form and poorly-aligned teeth. Its flexible nature also means that it offers improved retention for night-time use. Tongue tag, guard and elevators train the tongue to position properly. Small breathing holes and dual arch-form prevent mouth breathing (a common problem in Class III patients). Sunday, January 19, 14
  • 148. MYOBRACE FOR INTERCEPTIVE CLASS ™ III - I-3 Features Dynamicore™ with a Frankel Cage which assists in developing the arch-form and improving the dental alignment. Tongue tag, guard and elevators train the tongue to position properly. Small breathing holes and dual arch-form prevent mouth breathing (a common problem in Class III patients). Sunday, January 19, 14
  • 149. MYOBRACE FOR INTERCEPTIVE CLASS I-3H ™ III - Firm polyurethane construction provides excellent tooth alignment and retention. Hollow tongue tag; tongue guard and elevators train the tongue to sit in final correct position and prevent thumb sucking. Small breathing holes and dual arch-form prevent mouth breathing (a common problem in Class III patients). Sunday, January 19, 14
  • 150. ® MYOBRACE Sunday, January 19, 14 INTERCEPTIVE CLASS III
  • 151. Shields the soft tissue from brackets. Recommended Age Group: 12 - 15+ yrs Most effective during the early stages of permanent dentition Improves stability Speeds up orthodontic treatment Sunday, January 19, 14
  • 152. MYOFUNCTIONAL TREATMENT OF MALOCCLUSION BRACES SERIES Sunday, January 19, 14
  • 153. Sunday, January 19, 14
  • 154. STAGE 1 STAGE 2 HABIT CORRECTION ARCH EXPANSION 4-6 MONTHS 4-6 MONTHS Sunday, January 19, 14 STAGE 3 DENTAL ALIGNMENT 4-6 MONTHS STAGE 4 RETENTION 4-6 MONTHS
  • 155. ® MYOBRACE Sunday, January 19, 14 FOR TEENS
  • 156. MYOBRACE FOR ™ TEENS - T3 Features Dynamicore™ to assist in developing the arch-form which provides more space for the erupting dentition. The tooth slots separate and align the anterior teeth. Tongue tag, guard and elevators train the tongue to position properly. Sunday, January 19, 14
  • 157. ® MYOBRACE Sunday, January 19, 14 FOR LATE MIXED DENTITION
  • 158. Sunday, January 19, 14
  • 159. STAGE 1 HABIT CORRECTION 4-6 MONTHS Sunday, January 19, 14 STAGE 2 ARCH EXPANSION 4-6 MONTHS STAGE 3 FINAL ALIGNMENT & RETENTION 4-6 MONTHS
  • 160. MYOBRACE FOR ™ ADULTS - A1 Soft and flexible material adapts to a wide range of arch-forms and poorly aligned teeth.The soft material allows for better retention and comfort in the initial stages of treatment. Breathing holes assist the transition to correct nasal breathing. Extended lip bumper trains the lower lip. Sunday, January 19, 14
  • 161. MYOBRACE FOR ™ ADULTS - A2 Medium-hardness polyurethane provides arch development and puts small force on the teeth for improved dental alignment. Tongue tag, guard and elevators train the tongue to position properly. Extended lip bumper discourages strong, overactive lip muscles. Sunday, January 19, 14
  • 162. MYOBRACE FOR ™ ADULTS - A3 Firm polyurethane construction provides excellent tooth alignment and retention. Extended lip bumper discourages strong, overactive lip muscles. Hollow tongue tag; tongue guard and elevators train the tongue to sit in final correct position and prevent thumb sucking. Sunday, January 19, 14
  • 163. ® MYOBRACE Sunday, January 19, 14 FOR ADULTS
  • 164. MYOFUNCTIONAL ORTHODONTICS the new approach to the diagnosis, treatment and clinical management of malocclusion WHAT IS MRC CLINICAL APPLICATION PATIENT EDUCATION THE PROBLEM HOW TO START THE CAUSES OF MALOCCLUSION RESEARCH WHY IT WORKS Sunday, January 19, 14 CURRENT ORTHODONTIC S MYOFUNCTION AL ORTHODONTIC S
  • 165. MRC CLINICS CASE FILE No 1 Permanent dentition Blocked out Canine Sunday, January 19, 14
  • 166. Patient Name: MYOBRACE K1/BWS - K2 - K3 DOB 20.08.92 RHYS WADE - COOPER 21/04/2010 30 August 2005 Sunday, January 19, 14 21/04/2010 30 August 2005
  • 167. Patient Name: MYOBRACE K1/BWS - K2 - K3 DOB 20.08.92 RHYS WADE - COOPER 21/042010 30 August 2005 Sunday, January 19, 14 21/04/2010 30 August 2005
  • 168. Patient Name: MYOBRACE K1/BWS - K2 - K3 DOB 20.08.92 RHYS WADE - COOPER 26/10/10 30 August 2005 Sunday, January 19, 14 26/10/10 30 August 2005
  • 169. Patient Name: MYOBRACE K1/BWS - K2 - K3 DOB 20.08.92 RHYS WADE - COOPER 21/04/2010 30 August 2005 Sunday, January 19, 14 28/09/2011 30 August 2005
  • 170. MRC CLINICS CASE FILE No 2 Mixed Dentition Anterior Openbite Sunday, January 19, 14
  • 171. T4K - MYOBRACE K1 Patient Name: RHYS WADE - COOPER - DOB 20.08.92 10/11/2008 30 August 2005 Sunday, January 19, 14 10/11/2008 30 August 2005
  • 172. T4K - MYOBRACE K1 Patient Name: RHYS WADE - COOPER - DOB 20.08.92 12/07/10 30 August 2005 Sunday, January 19, 14 12/07/10 30 August 2005
  • 173. T4K - MYOBRACE K1 Patient Name: RHYS WADE - COOPER - DOB 20.08.92 10/11/2008 30 August 2005 Sunday, January 19, 14 12/07/10 30 August 2005
  • 174. 3. The Myobrace System 1.History and Purpose 2.Types and uses 3.Clinical Protocols 4.Patient Education and Motivation 5.Follow-ups and Trouble shooting Sunday, January 19, 14
  • 175. Pee Break Sunday, January 19, 14
  • 176. Sunday, January 19, 14
  • 177. Read the Package... Sunday, January 19, 14
  • 178. Read the Package... Sunday, January 19, 14
  • 179. Read the Package... Sunday, January 19, 14
  • 180. Read the Package... Sunday, January 19, 14
  • 181. Read the Package... Sunday, January 19, 14
  • 182. Read the Package... Sunday, January 19, 14
  • 183. Read the Package... Sunday, January 19, 14
  • 184. Read the Package... Sunday, January 19, 14
  • 185. Read the Package... Sunday, January 19, 14
  • 186. Read the Package... Sunday, January 19, 14
  • 187. Read the Package... Sunday, January 19, 14
  • 188. Read the Package... Sunday, January 19, 14
  • 189. Read the Package... Sunday, January 19, 14
  • 190. Read the Package... Sunday, January 19, 14
  • 191. Read the Package... Sunday, January 19, 14
  • 192. Sunday, January 19, 14
  • 193. 2.1) Protocols: Trainers 1) Appliance Delivery 2) Comfort check 3) Routine visits 4) Post treatment maintenance Sunday, January 19, 14
  • 194. 2.1.1) Protocols: Trainers: Appliance Delivery 1.The Try-on 2.“The Four Things” 1. Bite Down 2. Lips together 3. Breath through your nose 4. Tongue on Tag 3. “The Two Things” 1. Lips together 2. Tongue on Tag Sunday, January 19, 14
  • 195. 2.1.1) Protocols: Trainers: Appliance Delivery Sunday, January 19, 14
  • 196. 2.1.1) Protocols: Trainers: Appliance Delivery 1.The Try-on 2.The Two Things 3.Wearing Schedule 1.1hr/day plus sleeping 1.No “Two Things” while Sleeping 2.OK to Ramp up 5 min 10 min 20 min 30 min 5 min 10 min 20 min 30 min 5 min 10 min 20 min 5 min 10 min 5 min Sunday, January 19, 14 60min 60+sleep
  • 197. 2.1.1) Protocols: Trainers: Appliance Delivery 1.The Try-on 2.The Two Things 3.Wearing Schedule 1.1hr/day plus sleeping 1.No “Two Things” while Sleeping 2.OK to Ramp up 3.Choose activities and make calendar 4.OK to Split time Sun Activity 1 Activity 2 Sunday, January 19, 14 TV Mon Tue Homework Homework Wed Ride to Soccer Gaming Reading Gaming Reading Thu Homework Fri Sat TV Movie Laundary
  • 198. 2.1.1) Protocols: Trainers: Appliance Delivery 1. The Try-on 2. The Four Things 3. Wearing Schedule 4. Score Card Sunday, January 19, 14
  • 199. Sunday, January 19, 14
  • 200. Sunday, January 19, 14
  • 201. Sunday, January 19, 14
  • 202. Sunday, January 19, 14
  • 203. 2.1.1) Protocols: Trainers: Appliance Delivery 1.The Try-on 2.The Four Things 3.Wearing Schedule 4.Score Card 5.Warnings 1.Don’t chew 2.Don’t let Dog chew 3.Fee to replace $85-200 Sunday, January 19, 14
  • 204. 2.1.1) Protocols: Trainers: Appliance Delivery 1. The Try-on 2. “The Four Things” 3. Wearing Schedule 4. Score Card 5. Warnings 6. Send them home Sunday, January 19, 14
  • 205. Follow-up Visits • Activity Center – Child observed in group setting wearing the trainer • Exercise Review – Therapist reviews and assigns exercises – www.Trainerkids.com • Wire Expander and Trainer Adjustment – Seen by me at every visit • Progress Records – Photos, etc. Sunday, January 19, 14
  • 206. Sunday, January 19, 14
  • 207. Sunday, January 19, 14
  • 208. Length of Treatment • Depends on Growth • Depends on Cooperation • Usually, 12 (to 24 months) • Then monitor growth • Re-evaluate for Further Treatment –Braces??? Sunday, January 19, 14
  • 209. What’s the benefit? (especially if braces are needed anyway?) • • • • • • • • • • • Preventative rather than corrective Addresses the cause of the problem Better stability Less extractions Less stress on the jaw joints Better looking facial appearance Easier on the roots of the teeth Less time in braces Teeth are easier to clean Myobrace stays at home Better health through better breathing, posture, nutrition, etc • Reduced cost (if braces not needed) Sunday, January 19, 14
  • 210. What are the drawbacks? • Child and family must be motivated • For “perfection”, braces may be needed. Sunday, January 19, 14
  • 211. What’s the cost • Depends on Age • About 1/3-1/2 of braces • Includes everything up until baby teeth are lost –Except lost or broken appliances • My Guarantee Sunday, January 19, 14
  • 212. My Little-to-lose Proposition • Not the right treatment? : 90 % credit • Still need braces : 50% credit Sunday, January 19, 14
  • 213. 3. The Myobrace System 1.History and Purpose 2.Types and Uses 3.Clinical Protocols 4.Patient Education and Motivation 5.Follow-ups and Trouble shooting Sunday, January 19, 14
  • 214. Trainers: Comfort Check 2. How is your daytime wear? Great! Here’s my card Too Busy Education Not Linking to other activities Excuses Encouragement, • I was sick Offer alternatives • I told her she didn’t have to wear it. • We had a family blah blah • Sad Puppy Eyes (Bite your tongue) • Can’t Breathe, Gagging • • • • Sun Act ivit Act y1 ivit y2 Mo n TV Rea ding Ga min g Tue Ho me wor Ga min k g We d Rid e to Rea Soc ding cer Thu Fri Sat Ho me wor k Spo nge bob Lau nda ry Mo vie Airway training Sunday, January 19, 14
  • 215. Trainers: Comfort Check 3. Nighttime wear • Normally takes time • Can’t fall asleep • Falls Out At Night (FOAN) Taping Sunday, January 19, 14 Delay starting 15 Min before sleep, Airway training Check Daytime wear, Airway training
  • 216. Micro-pore, Paper Medical Tape Sunday, January 19, 14
  • 217. Trainers: Comfort Check 4. Motivation • Attitude check • Looking for results • Encourage Patience • Talk about alternatives Sunday, January 19, 14
  • 218. Trainers: Comfort Check 4. Motivation : The bicycle speech 7 out of 7 Sunday, January 19, 14
  • 219. Trainers: Comfort Check 4. Motivation : The bicycle speech 5 out of 7 Sunday, January 19, 14
  • 220. 3. The Myobrace System 1.History and Purpose 2.Types and Uses 3.Clinical Protocols 4.Patient Education and Motivation 5.Follow-ups and Trouble shooting Sunday, January 19, 14
  • 221. Trainers: Comfort Check So, how does it feel? Is it comfortable? 1.Buccal gingiva, especially around erupting teeth 2.Retromolar pads 3.Incisive papilla 4. Doesn’t fit over BWS 5.Unexplained apthous ulcers 6.Allergic Reactions 7.Unexpected results Sunday, January 19, 14
  • 222. 2.1.2) Protocols: Trainers: Comfort Check Comfort check Buccal Gingiva blanching 1. Comfort: Common irritations Buccal gingival, especially around erupting teeth Retromolar pads Incisive papilla Unexplained apthous ulcers Sunday, January 19, 14
  • 223. Trainers: Comfort Check Comfort check 1. Comfort: Common irritations Buccal gingival, especially around erupting teeth Retromolar pads Incisive papilla Unexplained apthous ulcers Sunday, January 19, 14
  • 224. Trainers: Comfort Check Comfort check 1. Comfort: Common irritations Buccal gingival, especially around erupting teeth Retromolar pads Incisive papilla Unexplained apthous ulcers Sunday, January 19, 14
  • 225. Trainers: Comfort Check Comfort check 1. Comfort: Common irritations Sunday, January 19, 14
  • 226. Trainers: Comfort Check Comfort check 1. Comfort: Common irritations Buccal gingival, especially around erupting teeth Retromolar pads Incisive papilla Unexplained apthous ulcers Sunday, January 19, 14
  • 227. Trainers: Comfort Check Retromolar Pads Sunday, January 19, 14
  • 228. Trainers: Comfort Check Retromolar Pads Sunday, January 19, 14
  • 229. Trainers: Comfort Check Retromolar Pads Sunday, January 19, 14
  • 230. Trainers: Comfort Check Incisive Papilla Sunday, January 19, 14
  • 231. Trainers: Comfort Check Incisive Papilla Sunday, January 19, 14
  • 232. Trainers: Comfort Check Doesn’t Fit over BWS Sunday, January 19, 14
  • 233. Trainers: Comfort Check Doesn’t Fit over BWS Sunday, January 19, 14
  • 234. Trainers: Comfort Check Doesn’t Fit over BWS Sunday, January 19, 14
  • 235. Trainers: Comfort Check Apthous Ulcers •Not related to contact with trainer • Use oral ointment • Restart use when sores gone • Ramp up time Sunday, January 19, 14
  • 236. Trainers: Comfort Check Allergic Reactions 3 Days of wear Sunday, January 19, 14
  • 237. Trainers: Comfort Check Allergic Reactions Sunday, January 19, 14
  • 238. Trainers: Comfort Check Allergic Reactions Next: T4K Hard Sunday, January 19, 14
  • 239. Unexpected Results Sunday, January 19, 14
  • 240. Airway-focused Orthodontics Tomorrow... 1.Airway-focused Diagnostics 2. Prevention 3.Undo the Damage already done 4. Establish Good Habits 5. Interdisciplinary Treatment Only by working together will we get to the root of the problem. Sunday, January 19, 14